Journal of Pediatric Orthopaedics - 2026-08-20 - Journal Article
Functional Outcomes of Pediatrics and Adolescent Pelvic Fractures: A Systematic Review.
Buckman V, Sun P, Blibo J, Pandya N
Topics
Key Takeaway
Across 14 studies and 731 pediatric pelvic fracture patients, >90% regained independent ambulation regardless of management strategy, with pelvic asymmetry (8.7%), limb length discrepancy (6.9%), and nonunion (1.1%) as the dominant structural complications.
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Summary
This PRISMA-compliant systematic review examined functional and structural outcomes of pediatric and adolescent pelvic fractures stratified by fracture stability and management strategy. Fourteen retrospective and prospective cohort studies plus case series were pooled; >90% of patients across all management strategies achieved independent ambulation and return to ADLs. Structural complications were uncommon but included pelvic asymmetry in 8.7% (22/253), limb length discrepancy in 6.9% (23/333), acetabular dysplasia in 1.7% (3/178), and nonunion in 1.1% (6/549).
Key Limitation
The predominance of retrospective cohorts and case series with heterogeneous outcome measures and variable follow-up durations limits the ability to draw causative conclusions about which specific fracture patterns or management strategies drive structural complications.
Original Abstract
BACKGROUND
Pelvic fractures are rare injuries, representing 1% to 2% of fractures among pediatric and adolescent populations. Although uncommon, these injuries differ significantly from adult fractures due to skeletal immaturity and increased potential for bone remodeling. Currently, there is limited understanding of the long-term outcomes of pediatric pelvic fractures. This study aims to review the functional outcomes of pediatric and adolescent pelvic fractures.
METHODS
Following PRISMA guidelines, a systematic review was performed using PubMed, Embase, Scopus, and Google Scholar databases. Three independent authors screened all eligible studies, extracted the data, and assessed risk of bias. The types of studies included in the analysis were retrospective and prospective human cohort studies, as well as case series. The primary outcome of interest was functional outcomes by fracture stability and management. Secondary outcomes included radiologic and structural complications. Weighted pooled analyses were conducted where feasible.
RESULTS
Fourteen studies (n=731) were included in the review. Across reporting studies, more than 90% of patients regained independent ambulation and returned to activities of daily living regardless of management strategy and fracture stability. Pelvic asymmetry was the most frequently reported structural complication, occurring in 22 of 253 patients (8.7%). Other structural complications included limb length discrepancy (23/333; 6.9%), acetabular dysplasia (3/178; 1.7%), and nonunion (6/549; 1.1%).
CONCLUSION
Pediatric and adolescent pelvic fractures demonstrate favorable functional outcomes when management strategies are appropriately aligned with fracture stability. However, operative fixation could be considered in selective patients with stable fractures who are hemodynamically stable and at low surgical risk to modify the risks of rare complications such as pelvic asymmetry, limb length discrepancy, and nonunion.
LEVEL OF EVIDENCE
Level III-systematic review of level I to IV studies.